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Release of Information Under the HITECH Act
By Kim Murphy-Abdouch, MPH, RHIA, FACHE

Meaningful use stages 1 and 2 and the final rule of the HITECH Privacy, Security, Enforcement, Breach, and Genetic Information Nondiscrimination Act present an opportunity to transform how health care organizations manage patient access to their protected health information (PHI). Both meaningful use and HITECH have placed emphasis on patient engagement through providing them with an electronic copy of their information, including diagnostic test results, problem lists, medication lists, and medication allergies, on request.

Each state sets the fees that may be charged for providing copies of medical records. States do not differentiate the fees that may be charged for individuals seeking to access and maintain their own PHI from the fees that may be charged to other third parties who use the information for business purposes, such as insurance underwriting and legal claims.

Beginning September 23, HITECH limits the fees that individuals may be charged for their PHI to the reasonable costs of labor for copying the PHI plus supplies and postage. So even if a state law establishes a per page fee of 25 cents, under HITECH, if the actual cost to the health care organization is only 10 cents per page, it may charge the individual only 10 cents.

It’s time to establish two separate tracks for managing release of information (ROI) under HITECH and meaningful use: one track for patients requesting access to their PHI and another for third parties that use the information to make a profit. Establishment of distinct policies, procedures, and fee structures for the two groups will help simplify and clarify a health care organization’s ROI functions.

As it relates to patients, HITECH limits the fees that may be charged. It’s anticipated that patients will seek access to information such as clinical summaries, diagnostic test results, problem lists, medication lists, and medication allergies. A standard patient record set that includes these items could be established and ROI staff trained to access that information in a standardized way could facilitate a timely response to patient requests. The reasonable cost of providing that patient record set could be determined in advance and communicated to patients.

As it relates to third parties, the fees as established by each state would apply. For example, in Texas, health care organizations can charge a fee of $44.35 for basic retrieval or processing, which includes the fee for providing the first 10 pages of copies. HITECH prohibits charging patients a retrieval fee, whether it is a standard fee or one based on actual retrieval costs.

Texas also allows a variable charge per page dependent on the number of pages. This also would be prohibited under HITECH, as the actual cost of printing a page for a patient must be established, regardless of the number of pages.

Additionally, Texas establishes a separate fee structure for records that are provided on a digital or other electronic media to include a retrieval or processing fee that may not exceed $80.36, plus the actual cost of mailing, shipping, or otherwise delivering the provided copies. Charging a patient for this retrieval or processing fee also would be prohibited under HITECH.

Establishing two separate tracks for ROI would place health care organizations in an position to effectively facilitate patients’ access to their PHI as envisioned under meaningful use and HITECH while ensuring that the organization is appropriately reimbursed by third parties that use the information to make a profit.

— Kim Murphy-Abdouch, MPH, RHIA, FACHE, is a clinical assistant professor and the clinical coordinator in the HIM department at Texas State University. She is board certified in health care administration and a member of the AHIMA Consumer Engagement Practice Council.